Reviewing appointment slot categorisation for IIF ACC-08

Reviewing appointment slot categorisation for IIF ACC-08

Primary Care IT released some searches relating to ACC-08 as part of the IIF 2022-23 v3.4 collection. As these run in Population Reporting it is only possible to analyse slot data where a patient has been booked into the slot, only giving half of the picture as it cannot look at future appointment slots which are still available to book.

We have produced a separate set of 4 Slot Reports which are to be run in Appointment Reporting. These have been designed to help track how slots are being used, and the impact of National Appointment Categories have on IIF's ACC-08 indicator.

ACC-08 indicator

Percentage of patients whose time from booking to appointment was two weeks or less
The groundwork for ACC-08 was laid in 2021 when IIF contained a requirement for Practices to ensure they had linked all of their slots to one of 26 National Appointment Categories by 30th June 2021. A comprehensive guidance document was available to help Practices understand what each Category represents and the types of slots which might be mapped to it.

For 2022-23 the lower threshold for points achievement is 85% and the upper threshold is 90%.
For 2023-24, the lower threshold was scheduled to increase to 90% and the upper threshold to increase to 98%, however on release of the business rules it has been confirmed that the thresholds will remain at the 2022-23 levels. 

There are eight National Appointment Categories covered in the scope of this indicator.
  1. General Consultation Acute
  2. General Consultation Routine
  3. Unplanned Clinical Activity
  4. Clinical Triage
  5. Walk-in
  6. Home Visit
  7. Care Home Visit
  8. Care Related Encounter but does not fit into any other category.
Take a few moments to look again at the category descriptions in the guidance document. Keep the document open as you might need it whilst reviewing the slots.

Practices where appointments are freely available up until a few days before the appointment might find themselves caught out by the 2 week requirement, especially if they open up appointments well in advance. There are several techniques which can be used to improve the reporting percentage.

The big question is whether it is worth chasing this indicator? Given ACC-08 has one of the highest number of points available (71) it looks quite attractive, but when you stop to think about the rules it is one where the effort is ongoing every year and involves every member of staff who books appointments, and might be influenced by the demands of the patients as well as clinical need.

Every Practice's appointment book is very different based on a multitude of factors, and may have existed in a similar state for a number of years prior to the COVID-19 pandemic. Over the past year, new ways of working and the inevitable backlog of patient demand may have caused the appointment book layout to change but the fundamentals of slot types, routine clinics, and clinical need may have been carried over.
Keep an open mind over the number of slot types (do we need more slot types?) and the category mapping. Is this an opportunity to train all staff to book appointments 'correctly', knowing how to change a slot type at the point of booking to correctly reflect the purpose?

Importing the Slot Reports

First go to Appointment Reporting. You can find this from the EMIS ball, under Appointments, or go to the Appointment Book and select the Appointment Reporting tab from along the top of the ribbon.

For users importing the searches:
  1. Click on your Practice name at the top of the document tree, then press Add > Folder.
  2. Name the folder IIF Appointment Reporting 2022-23
  3. Click on the new folder then press Import on the ribbon
  4. Press the Enquiry Document button and locate 025. IIF 2022-23 (Appointment Reporting).xml 
  5. Untick the top folder IIF 2022-23 then press OK
  6. You will see the following alert, just click continue:

IIF Appointment Slot Reports for ACC-08

The top two IIF-ACC08 reports show the count (total number of slots) and percentage of specified mapped slots which have been booked within 2 weeks of the appointment. This displays a breakdown by month of the slots based on booking time, including an overall annual average.

In the above example of IIF-ACC08) Booking time for first or acute appointments (percentage) , the Practice achieved 87% in April and May before any review of mapping had taken place. The mapping review exercise took place in the last week of May and the effect can be seen for June.  Looking at IIF-ACC08) Booking time for first or acute appointments (count) helps to quantify the situation.
Note the annual total which shows a running average of all booked appointments from 1st April 2022 through until 31st March 2023.

The bottom two reports (IIF-ACC08a - overview and IIF-ACC08b - session holder breakdown) can be used to assess how slots have been mapped.
The overview shows each National Slot Category and all of the local slot types mapped to it and their use in the appointment book, again broken down by month. 

The first exercise of the review is to look at how local slots have been mapped to national categories. It will help to have a number of staff from different areas to understand what each slot type is used for. The monthly numbers show how many slots exist within the month. The slot report might be a quick way of picking out erroneous mappings, but it will be necessary to use Appts Config if any slot mappings need to be changed. In the above example it is clear that some slots such as 'Blood Pressure Check' and 'Childrens Vaccinations' had been incorrectly mapped to General Consultation Routine when they should have both been mapped to Planned Clinical Procedure (which is not looked at by ACC-08).

The slot reports appear to remember the original mapping, so even after mappings have been changed, any existing slots on the appointment book retain the old mapping. This is helpful for keeping a track on reporting, but unhelpful if you want to come back to the overview report.
The session holder breakdown takes things one step further by breaking down each slot type by the users who have specified slot types applied to their sessions within the Appointment Book. This is an additional level of detail which may be helpful when trying to understand where slots are used, and possibly where to target Session Templates that need modifying if the slot type is inappropriate.
This report also helped to show where users still have the 'Default' slot type which may have been mapped to General Consultation Routine if Practices followed the official guidance - if ad-hoc sessions and slots are added to sessions using the Default slot type, the accumulation of these could significantly affect the achievement percentage for the indicator.

The second exercise is to introduce ways to ensure that affected slots are not booked more than 2 weeks in advance. One approach is to edit the name of the local slot types to make them distinguishable to staff so they know they can only be booked up to 2 weeks ahead. Unfortunately the slots can only use letters and numbers, so special characters such as asterisks cannot be used. The above screenshot of the overview shows how slots have been prefixed with '2W' to alert staff to the 2 week requirement. 
Consider if any of these slot types are online bookable - and appointments are configured to be bookable more than 2 weeks in advance - that online booking for the slots is removed OR an embargo is added to lift 2 weeks ahead.

Taking the embargo approach, a broad sweep of applying embargos to slots (built onto your Session Templates) might help to deter accidental use of the slots. Use an embargo designed to become available to book 2 weeks before the appointment time. Users must have RBAC B8015 to override embargos.

A third exercise is to inform and educate all members of staff who book appointments. Staff need to understand the implications for ACC-08 of booking more than 2 weeks ahead, and how to work around it.
There are added benefits to staff understanding how to change slots. Session holders can eyeball appointments by the slot colour or icon to know what they have booked, before reading down a list of reasons (if any have been added). Managers overseeing the appointment book will also have more accurate data when looking at appointment usage.

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